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LONGS DRUGS OF LEXINGTON
STD303311 Sisterlove Inc.
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Covered Entity Details
Entity Name
Sisterlove Inc.
Subdivision Name
Sisterlove Inc.
Type
Sexually Transmitted Diseases
340B ID
STD303311
Entity Address
3709 Bakers Ferry Road SW
Atlanta, GA 30331
Grant Number
NH25PS005184
Participating Start Date
1/1/2019
Last Recertification Date
5/6/2025
Pharmacy Details
Pharmacy Name
LONGS DRUGS OF LEXINGTON
Pharmacy Address
D/B/A AVITA PHARMACY 1051
1216 W MAIN ST
STE D
LEXINGTON, SC 29072-2453
Pharmacy Comments
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dazon Dixon Diallo, Founder/President
(404) 505-7777
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
1/15/2019
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